Management of Laryngotracheal Trauma: A Five-Year Single Institution Experience

Document Type: Original

Authors

1 Department of ENT and Head Neck Surgery, AIIMS Bhubaneswar, Bhubaneswar-751019, Odisha, India.

2 Department of ENT, Sri Lakshmi Narayana Institute of Medical Sciences, Pondicherry- 09, Pondicherry, India.

3 Department of ENT and Head Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India.

Abstract

Introduction:
Laryngotracheal trauma is a rare life-threatening emergency that requires early identification and immediate intervention. Here, we present 26 patients with laryngotracheal trauma from a tertiary hospital in India. The aim was to describe the clinical presentation and management of laryngotracheal trauma patients.
 
Materials and Methods:
This was a retrospective study of laryngotracheal trauma patients treated between January 2011 and March 2016. Patients who presented with a breach in the laryngotracheal framework were included, while those who had penetrating neck injuries superficial to strap muscles/platysma, burn injuries, caustic ingestion, or endotracheal injuries were excluded from the study.
 
Results:
Of 253 patients with neck injury, 26 (23 adults, three children; 21 males, five females; age range, 5-60 years) presented with a breach in the laryngotracheal framework (15 blunt neck-trauma patients and 11 penetrating neck-trauma patients). The most common cause of neck injury was road traffic accidents, seen in 12 patients (46.2%). Computed tomography (CT) was performed in all blunt trauma cases and in four patients with penetrating trauma. All penetrating trauma patients underwent neck exploration. Twelve blunt trauma patients (46.1%) were managed conservatively, while three (11.5%) required surgical intervention. The most common neck exploration finding noted in patients with a penetrating injury was fracture of the thyroid cartilage, which was seen in eight patients (30.8%). Twenty patients (76.9%) had a normal voice, five patients (19.2%) had a hoarse voice, and one patient (3.8%) had a breathy voice post treatment.
 
Conclusion:
Early intervention of laryngotracheal trauma is crucial. The role of a CT scan is essential in decision making in blunt trauma cases.

Keywords

Main Subjects


1. Aouad R, Moutran H, Rassi S. Laryngotracheal disruption after blunt neck trauma. Am J Emerg Med. 2007;25(9):1084.e1-2.

2. Schaefer SD. The treatment of acute external laryngeal injuries. 'State of the art'. Arch Otolaryngol Head Neck Surg. 1991;117(1):35-9.

3. Schaefer SD. The acute management of external laryngeal trauma. A 27-year experience. Arch Otolaryngol Head Neck Surg. 1992;118(6):598-604.

4. Corsten G, Berkowitz RG.Membranous tracheal rupture in children following minor blunt cervical trauma. Ann Otol Rhinol Laryngol. 2002;111:197-9.

5. Aich M, Khorshed Alam ABM, Talukder DC, Rouf Sarder MA, Fakir AY, Hossain M. Cut throat injury: review of 67 cases. Bangladesh J Otorhinolaryngol. 2011;17(3):5–13.

6. Sachdeva K, Upadhyay A. Neck Trauma: ENT Prospects. Indian J Otolaryngol Head  Neck Surg. 2017;69(1):52-7.

7. Akhtar S, Awan S. Laryngotracheal trauma: its management and sequelae. J Pak Med Assoc. 2008;58(5):241-3.

8. Yen PT, Lee HY, Tsai MH, Chan ST, Huang TS. Clinical analysis of external laryngeal trauma. J Laryngol Otol 1994;108(3):221–5.

9. Cherian TA, Rupra V, Raman R. External laryngeal trauma: analysis of thirty cases. J Laryngol Otol 1993;107(10):920–3.

10. Hwang SY, Yeak SC. Management dilemmas in laryngeal trauma. J Laryngol Otol. 2004;118 (5): 325-8.

11. Bell RB, Osborn T, Dierks EJ, Potter BE, Long WB. Management of penetrating neck injuries: a new paradigm for civilian trauma. J Oral. Maxillofac Surg.2007;65(4):691-705.

12. Scaglione M ,  Romano S ,  Pinto A ,  Sparano A,  Scialpi M ,  Rotondo A. Acute tracheobronchial injuries: impact of imaging on diagnosis and management implications. Eur J Radiol. 2006; 59(3): 336–43.

13. Stanley RB Jr. Value of computed tomography in management of acute laryngeal injury. J Trauma. 1984;24(4):359-62.

14. Foley MJ, Ghahremani GG, Rogers LF. Reappraisal of contrast media used to detect upper gastrointestinal perforations: comparison of ionic water-soluble media with barium sulfate. Radiology. 1982;144(2):231-7.

15. Schaefer SD. Management of acute blunt and penetrating external laryngeal trauma. Laryngoscope. 2014;124(1):233-44.

16. Bell RB, Verschueren DS, Dierks EJ. Management of laryngeal trauma. Oral Maxillofac Surg Clin North Am. 2008;20(3):415-30.

17. Stanley RB Jr, Colman MF. Unilateral Degloving Injuries of the Arytenoid Cartilage. Arch Otolaryngol Head Neck Surg. 1986; 112(5): 516-8.

18. Bent JP, Silver JR, Porubsky ES. Acute laryngeal trauma: a review of 77 patients. Otolaryngol Head Neck Surg. 1993;109(3 Pt 1):441-9.

19. Teng Y, Wang HE, Lin Z. Arytenoid cartilage dislocation from external blunt laryngeal trauma: evaluation and therapy without laryngeal electromyography. Med Sci Monit. 2014(8); 20: 1496-502.

20. Lee DH, Yoon TM, Lee JK, Lim SC. Treatment outcomes of closed reduction of arytenoid dislocation. Acta Otolaryngol. 2013; 133(5): 518-22.

21. Sperry JL, Moore EE, Coimbra R, Croce M, Davis JW, Karmy-Jones R et al. Western Trauma Association critical decisions in trauma: penetrating neck trauma. J Trauma Acute Care Surg. 2013;75(6):936–40.

22. Abujamra L, Joseph MM. Penetrating neck injuries in children: a retrospective review. Pediatr Emerg Care. 2003;19(5):308–13.

23. Hackett AM, Chi D, Kitsko DJ. Patterns of injury and otolaryngology intervention in paediatric neck trauma. Int J Pediatr Otorhinolaryngol. 2012;76(12):1751–4.

24. Kim MK, Buckman R, SzeremetaW. Penetrating neck trauma in children: an urban hospital's experience. Otolaryngol Head Neck Surg. 2000;123(4):439–43.

25.Vick LR, Islam S. Adding insult to injury: neck exploration for penetrating Paediatric neck trauma. Am Surg. 2008;74(11):1104–6.

26. Jalisi S, Zoccoli. Management of laryngeal fractures-a 10-year experience.  M J Voice. 2011; 25(4):473-9.